医学交流课件：慢性心衰的心率管理.pptVIP

* A multivariate analysis of the Cardiac Insufficiency BIsoprolol Study–II (CIBIS II),20 showed that the change in baseline heart rate was significantly related to survival and hospitalization in those heart failure patients in sinus rhythm. Patients were subdivided into tertiles of distribution of heart rate: for baseline rates, ≤72 bpm, between 72 and ≤84 bpm, and 84 bpm, In the three tertiles, the 1-year mortality was significantly related to baseline heart rate. Heart rate at baseline is a risk marker of cardiovascular death or hospitalization for heart failure in the SHIFT trial. Note that every beat increase at baseline is associated with a 3% increase of the composite end point and a 16% increase of risk per 5 pm increase. Beta受体阻滞剂确立在心衰中的基石已经10多年了，但是根据多项登记研究，CHF患者的平均心率超过70，与普通人群无异。 * 按照现有幻灯中的几个要点：流行病学，不同地区人群，因果关系，干预后结果，幅度与事件比例等?（附件幻灯里又） 2，??在伊伐布雷定为主的基础上，尽量把总部相关BB的幻灯一起用上，显得学术一些 3，??强调最佳心率60bpm以下 不超过30张片子，谢谢！ * * 伊伐布雷定进入If通道孔洞，与通道内部的结合位点偶联 伊伐布雷定与其它减慢心率药物不同，对If通道的抑制作用不仅是电压依赖性的，而且具有电流依赖性 In theory, there are four ways of reducing the heart sinus rate: By prolonging the action potential repolarization time By reducing maximal diastolic potential (more electronegative potential) By shifting the threshold potential to a more positive level By slowing the rate of diastolic depolarization This study shows that Procoralan only acts by reducing the slope of diastolic depolarization without significant changes in maximal diastolic potential Ivabradine specifically blocks f-channels in a concentration-dependent manner. The blocks occur when the drug enters the channel pore from the intracellular side and binds to a site within the ion pathway. Binding and unbinding of ivabradine occur when channel is in the open state. * Eight instrumented dogs were investigated during exercise at spontaneous and paced heart rate (250 bpm) after administration of saline, atenolol, or Ivabradine. Reduction in contractility with atenolol tended to reduce peak LV wall stress compared w